摘要
目的探讨早期胃癌内镜黏膜下剥离术(ESD)后追加外科手术的淋巴结转移和残留癌危险因素及预后。方法回顾性分析2012年8月—2019年8月在首都医科大学附属北京友谊医院普外科接受ESD术后追加外科手术的42例早期胃癌患者资料,其中男性35例,女性7例,男女比例为5∶1,平均年龄62岁(32~82岁)。主要研究指标为淋巴结转移风险和残留癌风险,次要研究指标为3年、5年总体生存率。采用Logistic回归模型分析淋巴结转移和残留癌危险因素,应用Kaplan-Meier进行生存分析。结果多因素分析显示性别(OR:45.3,95%CI:3.762~546.250,P=0.003)、侵犯深度(OR:3.965,95%CI:1.1019~15.432,P=0.047)、组织学类型(OR:9.455,95%CI:0.946~94.482,P=0.049)是影响早期胃癌淋巴结转移的独立危险因素。肿瘤浸润形式(OR:10.675,95%CI:1.840~61.932,P=0.008)和水平切缘(OR:9.341,95%CI:1.470~59.346,P=0.018)是影响残留癌发生的独立危险因素。分层分析显示:男性,肿瘤侵犯至T1b-SM1,病理类型为未分化型;以及女性,肿瘤侵犯至T1b-SM2,无论病理类型,均出现淋巴结转移。当水平切缘阳性,无论浸润形式如何;以及浸润形式为INF-c,无论水平切缘如何,均出现残留癌。生存分析显示:无淋巴结转移者3年(100%比60%,P<0.001)和5年总体生存率(100%比25%,P<0.001)均优于合并淋巴结转移者;无残留癌者3年(100%比80%)和5年总体生存率(100%比62.5%)显著优于有残留癌者,差异均有统计学意义(P<0.001)。结论性别、侵犯深度、组织学类型是影响早期胃癌淋巴结转移的独立危险因素,肿瘤浸润形式和水平切缘是影响残留癌出现的独立危险因素。无淋巴结转移和无残留癌的早期胃癌患者远期生存率优于伴有淋巴结转移以及残留癌出现的患者。因此,对于早期胃癌患者来说,ESD是安全、有效的治疗方式之一,但是部分患者需要依据具体情况追加外科手术以期改善预后。
Objective To explore the risk factors and prognosis of lymph node metastasis and residual cancer following additional surgery after endoscopic submucosal dissection(ESD)in early gastric cancer(EGC).Methods Retrospective analysis was performed on the data of 42 patients with EGC who received additional surgery after ESD in General Surgery Department of Beijing Friendship Hospital,Capital Medical University from August 2012 to August 2019,including 35 males and 7 females,with a male to female ratio of 5∶1 and an average age of 62(32 to 82 years old).The primary outcomes were lymph node metastasis risk and residual cancer risk,while the secondary outcomes were 3-year and 5-year overall survival.Logistic regression model was used to analyze the risk factors of lymph node metastasis and residual cancer,and Kaplan-Meier survival analysis was performed.Results Multivariate analysis showed that gender(OR:45.3,95%CI:3.762-546.250,P=0.003),invasion depth(OR:3.965,95%CI:1.1019-15.432,P=0.047)and histological type(OR:9.455,95%CI:0.946-94.482,P=0.049)were independent risk factors for lymph node metastasis of early gastric cancer.The type of tumor invasion(OR:10.675,95%CI:1.840-61.932,P=0.008)and the horizontal resection margin(OR:9.341,95%CI:1.47-59.346,P=0.018)were independent risk factors affecting the occurrence of residual cancer.Stratified analysis showed that in men,the tumor invaded to T1b-SM1,and the pathological type was undifferentiated;and in women,the tumor invaded to T1b-SM2,regardless of the pathological type,lymph node metastasis occurred.When the horizontal margin was positive,regardless of the infiltration pattern;and the infiltration pattern is INF-c,regardless of the horizontal margin,residual cancer occurred.Survival analysis showed that the 3-year(100%vs 60%,P<0.001)and 5-year overall survival rate(100%vs 25%,P<0.001)were better than those with lymph node metastasis.The 3-year(100%vs 80%)and 5-year overall survival rates(100%vs 62.5%)of patients without residual cancer were significantly better than tho
作者
郑智
陈豪
尹杰
蔡军
闫笑生
张军
姚宏伟
张忠涛
Zheng Zhi;Chen Hao;Yin Jie;Cai Jun;Yan Xiaosheng;Zhang Jun;Yao Hongwei;Zhang Zhongtao(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,Beijing 100050,China)
出处
《国际外科学杂志》
2020年第8期527-534,F0003,F0004,共10页
International Journal of Surgery
基金
北京市科委重大项目资金资助(D171100006517003)。
关键词
胃肿瘤
外科手术
淋巴转移
内镜下黏膜下切除术
补救手术
多因素分析
生存分析
Stomach neoplasms
Surgical procedures,operative
Lymphatic metastasis
Endoscopic submucosal resection
Additional surgery
Logistic regression
Survival analysis
